Onychomycosis is a common, chronic, and recurring fungal infection of the toenails or, less frequently, the fingernails. Onychomycosis is the most common nail disorder in adults, accounting for about half of all nail disorders, with an estimated prevalence in the United States of nearly 14%. While not life threatening, the disease should not be considered purely a cosmetic problem. Significant physical and psychological effects, such as pain and decreased self-esteem, may occur.
Current onychomycosis treatment strategies include both oral and topical antifungal agents (such as itraconazole (Sporanox®) and terbinafine (Lamisil®)), but the successful management of the disease can be challenging. An oral antifungal currently is the preferred first line therapy because of its superior efficacy and shorter treatment duration. Ciclopirox lacquer (approved by the U.S. Food and Drug Administration in 1999 as Penlac® Nail Lacquer and now available in various generics), has demonstrated modest efficacy in treating mild to moderate onychomycosis not involving the lunula (Gupta 2005) with reported complete cure rates of 5.5% to 8.5% (Gupta 2000b). Frequent debridement is required when using this product.